Organization
TIMOTHY A. BENICH DDS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY BENICH (OWNER)
(770) 924-0157
Entity
Organization
Contact information
Practice address
6304 OLD HIGHWAY 5, 100, WOODSTOCK, GA 30188-2452
(770) 924-0157
Mailing address
6304 OLD HIGHWAY 5, 100, WOODSTOCK, GA 30188-2452
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
7987
GA
Other
Enumeration date
08/07/2014
Last updated
08/07/2014
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